- In 2000, 27.3 percent of Medicare decedents used hospice. In 2005, that number had increased to roughly 40 percent.
- The average length of stay in hospice has increased over this period. Between 1998 and 2000, the average was 48 days; between 2000 and 2005, it was 67 days.
- The provider mix of hospices has changed since 1983, when Medicare implemented the hospice benefit. In 1983, most providers were nonprofits affiliated with religious or community organization. Today, for-profit hospices are the majority.
- A small but growing number of hospice are exceeding the "hospice cap," the aggregate per patient limit on Medicare payments for hospice services. [Payments are made on a per diem basis across four general types of care.]
- In 2002, 2.6 percent of hospices exceeded the cap. In 2005, 7.8 percent exceeded it.
- Spending on the Medicare hospice benefit has increased due to greater numbers of beneficiaries, as well as longer hospice stays. The longer stays are consistent with the growth of noncancer diagnoses (such as Alzheimer's disease and dementia.)
- The report concludes a combination of provider characteristics (for-profit vs nonprofit), patient diagnoses, and market conditions were correlated to the likelihood that hospice would exceed the cap. The number of hospices exceeding the cap is still small, just under 8 percent of hospice providers in 2005. In addition, hospices exceeding the cap were more likely to be for-profit, freestanding facilities with smaller patient loads.
- Other market forces involved in longer lengths of stay may include: whether a hospice is a new entrant into the market, the number of Medicare beneficiaries per hospice provider, patients wanting the benefit for longer periods, and the financial incentives of the current payment system.
- Growth in hospice use was higher among women than men, higher among whites and blacks than those of Hispanics and Asian heritage. Use by Native Americans doubled between 2000 and 2005. Use also grew the fastest for the oldest patients, those 85 and older.
Items we noted:
- The report details the financial incentives for hospices to provider longer stays, but also states a lack of data does not allow them to "determine conclusively whether the payment system encourages or discourages the admission of certain patients to hospice on the basis of their profitability."
- It highlighted that CMS does not currently require hospices to report quality of care, but that the new Conditions of Participation will need to provide quality assessment. The report points out the challenges of implementing quality assessment and discusses options.
- The report makes this statement, "The hospice payment system should be changed to minimize incentives that make some patients more profitable than others, so that access is equal for all Medicare beneficiaries who wish to use the benefit." The report does not provide suggestions for an alternate payment system, however.
